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DEPARTMENT OF CORRECTIONS. Last week, I linked to The Politico's report that Obama had endorsed mandates for health care last year, before releasing a plan devoid of such provisions this year. That report, it seems, was wrong. A fuller transcription of his quote is below the fold, and it's clear in this version that he was offering mandates as one idea, not personally backing the concept. Meanwhile, Len Nichols -- who, if I had to choose, would certainly be my personal health policy guru -- has an article explaining why an individual mandate is so important. Well worth a read .
--Ezra Klein (Full Obama quote below the jump)
"...I think it's time for us to go ahead and say that we should have some kind of basic health care for every American. We can do it efficiently, we can have some private sector involvement in it. Let me give you an example - a Republican example, or an example of an initiative that's been adopted by a Republican governor. His basic idea is we're going to treat health insurance like auto insurance. It's mandatory. If you already have coverage through Medicare, or Medicaid, you keep that. If you have coverage through your employer, you keep that. But there are some of you that are healthy, and you've just decided you don't want to have health insurance. Well, sorry, you've got to buy it. That means the pool is then expanded because everyone has to buy in. And then there are some of you who want health insurance but can't afford it, and that's where the government steps and provides you a subsidy. That's just one example - you'd still have private insurance companies involved. What they did over there, is they set up a pool, just like Federal employees have a pool, that drives the cost down so that any individual subsidy given to any individual family could be lower. The point though is that if you get everybody in that drives down costs for everyone. Now. What is the level of coverage that everybody gets? Well, it's not going to be a Cadillac, it's going to be a Corolla, and then if you want a Cadillac you've got to pay extra. That's just one way of doing it. You could do the same concept through Medicare, just adding more and more cohorts through Medicare. We could start by at least making sure that all children are covered, and i think this is where Governor Blagoiovich has the right idea, by saying that there shouldn't be any child in Illinois that doesn't have coverage."
COMMENTS (5)
Thanks for your correction post. Props for that.
I read the Len Nichols article and it's quite good...but is still missing a key point. I don't think anyone argues that increasing the pool size isn't important and that we should try to avoid so-called "free-riders".
The question in my mind is simple: what evidence does anyone have that an individual mandate would actually do anything?
People seem to be saying that if you make health insurance mandatory for adults, they'll be forced to sign up and thus we'll avoid the free-riders. Forced how, exactly? It's not just an academic exercise. If you "mandate" something, you've got to have an enforcement mechanism. Every discussion I've seen seems to pretend that once we announce the mandate, we're done...everyone will sign up because they're "forced" to.
I fail to see how people who are today voluntarily not signing up for healthcare...are going to sign up tomorrow because the government says so. The government also told me I had to pay my taxes...but I'm pretty sure lots of folks did it only because otherwise the IRS might go after them. And lots of folks gamble that they won't get caught in an audit.
A mandate without an explicit description of how to enforce it is meaningless...except in the land of academic exercise. How does Massachusetts intend to enforce its mandate, for example? That would go a long way towards seeing if a mandate is really viable or useful.
Posted by: rashomon | June 4, 2007 3:17 PM
To answer my own question, here's how Massachusetts plans to enforce their mandate.
6. If employees don’t have health insurance, what consequences will they face as individuals?
The health care reform law created a requirement that all Massachusetts residents age 18 and over (with some exceptions) obtain and maintain health insurance that meets minimum coverage requirements beginning July 1, 2007. This is known as the individual mandate.
With some exceptions, individuals who cannot show proof of health insurance coverage that meets the standard of minimum creditable coverage by Dec. 31, 2007, will lose their personal income tax exemption when filing their 2007 income taxes.
Failure to meet the individual mandate in 2008 will result in a fine for each month the individual does not have coverage. The fine will equal 50 percent of the least costly, available insurance premium that meets the standard for minimum creditable coverage.
7. Who will oversee enforcement of the individual mandate?
The Department of Revenue will enforce the individual mandate through the state personal income tax collection process.
Source:
http://www.therevgroup.com/index.php?option=com_content&task=view&id=37&Itemid=89
So, apparently it's going to be enforced through the tax system. Looks like we'll get to see how effective this approach is soon.
Posted by: rashomon | June 4, 2007 4:26 PM
FYI - Obama has a Letter to the Editor in the Boston Globe regarding an editorial critical of his health care plan:
"AN EDITORIAL on May 30 ("Obama's incomplete health plan") stated that my universal health care plan would not cover everyone. That's simply inaccurate. My plan will cover every American.
Under my plan, the uninsured can buy health care similar to what federal employees have. No one would be denied health insurance because of preexisting conditions or illnesses. If you cannot afford insurance, you'll receive a subsidy to pay for it. If you have children, they'll be covered. If you change jobs, your insurance will go with you.
Once this plan is implemented, if you're still not covered, we'll find a way to cover you. We have the resources set aside to cover everyone.
But a truly universal plan cannot stop at coverage. It must take unprecedented steps to address the skyrocketing cost of health care. And my plan will cut the cost of every family's premiums by up to $2,500.
The major reason that 45 million Americans don't have health care is not that they don't want it, it's that they can't afford it. If we require people to purchase insurance before we bring down its cost, we'll make a bad problem worse.
If we want to cover everyone, we must cut costs for everyone.
SENATOR BARACK OBAMA
Chicago"
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